Provider Demographics
NPI:1013944933
Name:IKELER, GEORGE RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RAYMOND
Last Name:IKELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31450 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9594
Mailing Address - Country:US
Mailing Address - Phone:352-735-4044
Mailing Address - Fax:352-735-2536
Practice Address - Street 1:31450 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9594
Practice Address - Country:US
Practice Address - Phone:352-735-4033
Practice Address - Fax:352-735-2536
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043349700Medicaid
FL043349700Medicaid
FLD54305Medicare UPIN
FL35077ZMedicare Oscar/Certification